How Would You Deal with this Referral?

Jan 15, 2016

  1. sam816
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    sam816 Super Genius

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    A doctor's office is ending their contract with MAPD plan A, they referred some of their patients who are on plan A to me, wanting me to help them sign up for plan B. The problem is plan B is a captive one and I don't have it. I told those who called I could show them plan C which allows them to see the same doctor but is not as good as plan A, but I don't represent plan B so I can't help them with that.

    The problem is plan B is more competitive than plan C, would you go as far as telling them that they will be better off by just calling plan B themselves?
     
    sam816, Jan 15, 2016
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  2. sman
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    sman Guru

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    Since we're outside of AEP, my recommendation would be to tell them to find a new doctor since they won't be able to change plans until next year (unless they can get a SEP from Medicare or they are DUAL/SNP).
     
    sman, Jan 15, 2016
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  3. sam816
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    sam816 Super Genius

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    Sorry, I should have said all these plans are DUAL/SNP therefore they can switch plans outside the AEP.
     
    sam816, Jan 15, 2016
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  4. vic120
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    vic120 Guru

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    I have a doc that refers to me on occasion for MA. I was very straightforward on what plans I do and do not represent, especially because this year, one of the plans the doc likes is one I do not represent.

    I also put together a grid including benefits of plans I represent.I also provided direct number to the plans I do not represent

    The Doc appreciates this and refers whenever feasible and sends direct when needed.

    The way I look at it is it is free deals anyway, whatever I get I am am grateful, I don't stress what I don't because of limitations.It all works out well enough for me
     
    vic120, Jan 15, 2016
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  5. Todd King
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    Todd King IMO/FMO Owner

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    Would it be that difficult for you to pick up plan B and have it available?
     
  6. sam816
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    sam816 Super Genius

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    As far as I know it is a captive plan and they don't sell it through independent agents.
     
    sam816, Jan 15, 2016
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  7. vic120
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    vic120 Guru

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    what is the name of company?
     
    vic120, Jan 15, 2016
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  8. sman
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    sman Guru

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    I'm a firm believer in doing what is best for the client. If we're talking a big difference in benefits, you've got to tell them the other plan could be a better option for them. I couldn't in good conscience knowingly enroll them in an inferior plan.

    Just my two cents.
     
    sman, Jan 15, 2016
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  9. Chazm
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    Chazm Guru

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    If it's a dual eligible plan, isnt it all $0 copays anyways?
    If so I would put them with plan C. Only thing extra is over the counter etc
     
    Chazm, Jan 15, 2016
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  10. wehotex
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    wehotex Guru

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    Any chance of befriending one of those captive agents? I know from experience in not being able to write a preferred plan that it sucks to have to give away what you have worked for in the hope that the lead recipient might reciprocate. I kissed a lot of frog agents until I found the princes/princesses that actually cared enough to give back. It's always best to give the client the best option. If you don't, they could only end up disenrolling eventually.
     
    wehotex, Jan 15, 2016
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